As of April 1st 2020 brand name Truvada® will no longer be available on the PBS, however you will be able to buy other generic brands which are just as effective and will work as PrEP.
Today we are better equipped than ever before when it comes to preventing HIV transmission, however as our prevention options have increased and varied, the way we talk and negotiate safe sex has to change as well.
Do you do it with condoms?
This option is a classic, much like a Nokia 3310, condoms have proved time and time again their reliability and durability. When used correctly they continue to be one of the most effective ways to enjoy sex, while at the same time protect yourself and your partners from HIV.
Here’s why condoms are an effective HIV prevention method:
- Not only do they protect you and your partners from HIV, but they are also very effective at preventing many STIs
- With consistent use and lots of water or silicon-based lube, they’re incredibly effective
- They’re a great option if you have or enjoy casual sex
- They are relatively cheap, easy to use and free in some places
- Condoms can be used to stay safe if your partner(s) is HIV positive and is not on treatment or cannot achieve a UVL (undetectable viral load)
- If you’re unsure of the HIV status of your partner(s)
- If you’re still not sure if PrEP is right for you, condoms are a great alternative
Do you do it with PrEP?
We’re not here to judge, but within our colourful and diverse community, there some guys who choose not to use condoms for a variety of reasons. If this is you, PrEP may be worth considering an effective alternative.
PrEP stands for Pre-Exposure Prophylaxis, which is a daily pill taken to prevent you from getting HIV. Commonly known by the brand name TRUVADA, there are a few generic versions now available which use the same chemical compound of emtricitabine and tenofovir. Before starting PrEP there are a few considerations needed and it is important to remember, it can only be taken if you’re HIV negative.
PrEP may be worth considering as a HIV prevention method if you:
- Have frequent casual sex with multiple partners
- Use party drugs
- Attend sex parties
- Are in a serodiscordant relationship (where you and your partner are of mismatching HIV-statuses) and your partner is currently not on treatment
- Choose not to use condoms
Once you start taking PrEP it will take 7 days for the medication to take effect, at which point you will have enough of the drug in your system to significantly reduce the risk of HIV transmission.
For some guys PrEP is a great prevention method that puts their minds at ease. The best way to know if PrEP is the right choice for you is to speak to your doctor or sexual health care provider.
If you would like to speak to someone about PrEP and possible ways to access PrEP in NSW, EPIC-NSW is a study which provides PrEP to gay men who are at ‘high’ risk of HIV. You can contact the NSW Sexual Health Info Link on 1800 451 624.
Do you do it with UVL?
UVL is an acronym for Undetectable Viral Load that is sometimes also referred to as +U or undetectable. UVL is a term used to explain the level of HIV present in a positive guy’s blood. When that level drops below a certain threshold it’s considered ‘undetectable’ meaning that the amount of the virus in the blood is so low that it can’t be detected and therefore cannot be transmitted.
It is important to remember that undetectable, does not mean HIV negative, however maintaining an undetectable viral load does have significant health benefits for the person taking treatment.
If you’re HIV positive, we know that treating early is critical to strengthening your immune system’s ability to combat the infection. With antiretroviral medication, you can decrease your viral load to undetectable levels and know that you will not transmit HIV to your partner(s).
Do you do it with a combination?
Condoms, PrEP, UVL are all considered ‘safe sex’ and these options work best when they are matched with your lifestyle and situations you experience. Remember, the best prevention option for you is the one that you can use consistently and correctly.
It’s important to remember that as your life changes you may also choose to use different methods to stay safe. Or depending on who or how you are having sex you may choose to combine options. Here are some ways to combine them:
Condoms + PrEP
As we mentioned earlier, if you’re HIV negative and you think taking PrEP daily is a suitable option, that’s fantastic – congratulations on taking that step in taking control of your sexual health. While you are taking PrEP, there may be some situations in which you still may choose to use condoms; for example, you may be concerned that you or your partner may have picked up an STI – in this case, condoms combined with PrEP is a great option for staying safe.
Another instance for which you may choose to use a condom is based on your sexual partner. While PrEP has been around for a few years now, not everyone is comfortable using this as their main prevention strategy. During the negotiation or discussion with your potential partner, they may insist on using condoms – again, in this case it is completely up to you and your partner.
When choosing to use PrEP and/or condoms this is best done through negotiation. As a community we shouldn’t judge or shame one another for the choices they make to stay safe.
PrEP + UVL + Condoms
When we talk about combining prevention strategies, we don’t necessarily mean using all three at the same time so that you have the ‘ultimate’ protection – we’re talking about choosing which ones suit you and your situation.
However, there may be some instances in which you find all three of the prevention options are working the best. A classic example of this may be when you are at a sex party, incredibly hot men playing and fucking everywhere, each using their prevention option of choice and what makes them feel confident and safe.
There might be positive guys with UVL there, negative guys who are taking PrEP, a real mix of situations and with the excitement that makes the party buzz, there is the need to understand what your options are for staying safe.
Realising that everyone has their limits and safe zones, respecting each other’s preferences for how they decide to stay safe and that different sexual acts mean different risks, all add up to your choice to say yes please, nah or a hard no. In 2017, this is now the same for HIV prevention. Be confident and informed in your choice, know where your limits are and what you feel comfortable with.
Some other situations where multiple prevention strategies play out at the same time could be within the context of ‘open’ or non-monogamous relationships. You may also have a different partner for each day of the week – again no judgement. You may have your chosen strategy with your primary partner, be it UVL or PrEP, however for secondary or casual partners you might be using an alternative. How you choose your HIV prevention is up to you and what you think works for your situation. It’s that easy!
What’s important is communicating with your partners, particularly within serodiscordant relationships. Keep talking regularly about the safe sex methods you are choosing to use to keep each other safe.
PrEP + UVL
Some serodiscordant couples negotiate to use either PrEP or UVL as their main way of enjoying the sex they want, while at the same time as reducing their risk of HIV transmission. It is important to note here, that there is significant evidence through both Australian and international studies that prove there is no risk of HIV transmission from someone with an undetectable viral load. And if you are in a serodiscordant relationship with someone who is undetectable, you can be confident in choosing this as a HIV prevention strategy.
For example, if you were in a serodiscordant relationship and your partner is currently on treatment, according to the eligibility guidelines for EPIC-NSW (Australia’s largest PrEP study) you would be ineligible for the study. This is because prevention experts and clinicians are confident in UVL as a safe sex prevention option.
While we don’t want it to sound doom and gloom, the important element to factor into your decision making here is STIs. Having an STI can increase the viral load of the positive partner, as well as be potentially uncomfortable for the negative partner. However if you and your partner are both testing regularly you can be confident in the early detection and treatment of other STIs because of the regular tests you are receiving.
While you may be both confident with the choice you have made between the two of you, if you wanted to open up your relationship, it might be a good idea to re-introduce condoms again at that point.
UVL + Condoms
If you are HIV positive and have an undetectable viral load, adherence to treatment and routinely checking your viral load with your doctor is key. This is to ensure that your current treatment regime is working for you and keeping your body and immune system healthy.
Knowing your viral load is also essential for using this as a HIV prevention strategy. It is important to remember that having an STI may increase a positive guy’s viral load. So if you are concerned about this or concerned about STIs generally, you may continue to use condoms, along with water or silicon-based lubricant.
Together, we’re Ending HIV
When we talk about staying safe, we mean that the options are now here for you to choose and decide – what might work for one guy, might not be your prevention option of choice and so you’ll choose another one. Using more than one can happen, it’s up to you and your partner, it’s that simple and that’s the complexity of all the sexy situations out there.
By choosing to use condoms, PrEP or antiretroviral drugs to achieve a UVL, you’re actively helping to reach our goal of ending HIV by 2020. It’s important to know your status so you can stay safe, book a test now, or get in touch with us for more information on staying safe and reducing risk of HIV.
That’s how you do it.